Provider Demographics
NPI:1184040552
Name:MACK, CATHY J (HAIR REPLACEMENT)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:J
Last Name:MACK
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 REIDY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8555
Mailing Address - Country:US
Mailing Address - Phone:803-477-5243
Mailing Address - Fax:
Practice Address - Street 1:201 COLUMBIA MALL BLVD STE 189
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223
Practice Address - Country:US
Practice Address - Phone:803-477-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty